Treating non responding TMD pain patients requires and objective scientific investigative analysis of the patient’s physiologic responses. Since most dental school curriculum lack a scientifically measured physiologic basis to understand anatomical muscle dynamics and mandibular function (although they think they do), they really do not have clarity as to what “stable joints” or stable muscles really mean even if they use the word “stable” since the very foundation of their premise does not quantify neither does it measure the very essence of how the actin and myosin protein filaments (the foundational and elemental bio-physiologic components of muscle fiber) act within and arouond the human jaw.

Stability is an isotonic (homeostasis) state. It can be determined, but will involve the quantifying the quality of muscle activity (the health condition) of the associated structures of the masticatory system (teeth, muscles and temporomandibular joints) by the dentist. Stability cannot be assumed and deemed stable unless objective measurements are used to record various bio physiologic muscle activity levels of the masticatory system.

Actin and myosin is the foundational elements of dental occlusion. Without a physiologic basis to understand how muscles and jaw joints operate and or respond to different vector of forces the learning dental student is forced to focus their TMD understanding of orofacial pain on a psychosomatic model of pain which naturally does not lead to many clear and reasonable answers, especially when treating these entities (teeth, muscles and temporomandibular joints). Most TMD pain doesn’t come from the temporomandibular joints, but rather from the strained tight muscles and teeth. Tight muscle physiology (hypertonicities) are not understood with the mechanical model of how the jaw and associated entities operate since they cannot be measure or quantified by radiographic imaging tools alone. Because the focus of these dental schools is based on the mechanics of how teeth, joints and skull bone operates they are left with many missing gaps in physiology, biology, neuromuscular sciences that are not connected to functional anatomy and dynamics, thus what seemingly is a logical premise of pain and discomfort (psychosomatic) doesn’t always fit the paradigms of a mechanical models of how the jaw and occlusion works (somatopsychic). So they naturally conclude occlusion is not really a factor since teeth orthodontically can move. But this conclusion is somewhat deceiving and erroneous – lacks complete measurable physiologic basis. It is great for academics…but does nothing to enhance the working clinician’s knowledge basis for doing real time dentistry.

But there is a difference between slow cook orthodontic occlusal thinking vs. fast cook restorative prosthetic occlusal thinking. Both of these aspects of dentistry when viewed from a physiologic neuromuscular somatic-psychic perspective based on measuring of muscle activity before and after muscle relaxation modalities, combined with accurate jaw location and functional jaw relationship parameters begins to bring a logical and clearer perspective that makes more sense as to how TMD, occlusion and muscle physiologic relates to one another regardless of dental disciplines of TMD, orthodontics and or restorative/prosthetics.

One will have to first realize that objective measuring technology can measure muscle physiologic accurately and objective measuring technology can measure mandibular location and positional relationship and conditions accurately. Without accepting this premise that measuring instrumentation is of value in the scientific community of dentistry, all bets are off as to the conclusions various entities and leaders will continue to draw as they for “their opinion” as to how what TMD and orofacial pain is really about.